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LAND USE PERMIT APPLICATION — Burnett County, WI <br /> Applicant Complete All Sections Below This Line - <br /> CD , <br /> Permit Types and Fees:(Please,check appropriate boxes) °- <br /> Dwelling/Principal Structure $300 Addition/Alteration to Dwelling/Principal Structure $200 w <br /> ro <br /> Commercial/Industrial Structure $300 Addition/Alteration to Commercial/Industrial Structure $200 � <br /> Accessory Structure(Garage,Shed,etc.) $150 Addition/Alteration to Accessory Structure $1500 <br /> Accessory Structure(Commercial/Industrial) $200 Addition/Alteration to Bunkhouse $1509%. <br /> 150 ' <br /> Deck/Stairs/Patio/Retaining Wall/Sidewalk Bunkhouse $250 <br /> Driveways/&Campground Structures $125 WI State Statute 59.692(1v)Structures $350 . <br /> Filling/Grading $150 Boathouse $500 r- 'AP <br /> Six Month Camping Unit(One Per Year) $100 Permit Extension(1 Year Extension-Allowed Once) $100 o 110 <br /> *NOTE:After-the-factpermits G <br /> (permit aquired after construction has begun)may cost up to three times the normal fee. <br /> *Communication Towers&Signs require a different application form;see corresponding application,and fees. <br /> *Items not listed above will be treated as accessory structures,such as:pergolas,landscaping,etc. <br /> Property Owner's Name: OW� /�C / ° <br /> I‘ <br /> 1 1 ^n <br /> Property Owner's Mailing Address: 8 r <br /> p. G 1 / / Cit , State Zip , ' <br /> Property Site Address: �i' O �0 3 . p1�"►�4c %e. iGc e5$ �� GJ g'�8'3/ <br /> Contact's Telephone Number: 7/$•-P3//O 7 7N'" <br /> Contact's Email: 5--L e I 1 r e eA-,e- 'O 6 Ej:Mez4/,ec:), \ o <br /> ED <br /> Legal Description of Property: Pet r7- o-c Go,- 7 i'4 ier$ BU'', <br /> SfrGe,ke. a b <br /> Section#: 2., Town#: 3 7 N Range#: W Town of: a ,c,5. <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* d <br /> Tax ID#(1-5 digit number; found on tax statement): 2.41 39 2- <br /> Proposed Use of Structure/Addition: bel Nap e.-- u, <br /> D <br /> Anticipated Start Date: (Home/Cabin;Commercial Business:Bedroom;Deck;etc.) 7 P <br /> 70 a \ 5 <br /> Building Contractor: Sewer Installer: 1 <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> w H <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> **The applicant needs to contact their UDC Inspector to determine if a permit is needed from them prior to <br /> ANY construction taking place for any dwellings,dwelling additions,manufactured homes, manufactured z <br /> home additions,and bunkhouses.** P <br /> 07711s as - r fZC.— 9ar0/7L aS a fpn9ve.itZ 41 ( IM.-/9—e60. /, <br /> 10 Fo//o W O// Gox ch;4 0' 14,s at t/a 44.d /H garyadice_ 490,frot/4/, .15 <br /> 3 Ale( 7v d used 4 r A u s•+.av& tlaloti Ti ii, / <br /> IQ 1M WCC S re c-c h✓ec 0 P%. 10/SiZO1? `i o j eA/tr 40 4PPk e"774;A Few: /COI°O <br /> wy su6t i,��f%I Tvr 1 is perL"V71 ,, ti <br /> Date of staff site visit: 712,s//2o/9 Initials of site visit staff: D.1- Z <br /> 272002./ <br /> � / 0 <br /> rn <br /> APPROVED BY LAND SERVICES OFFICIAL: ................. I . E: 272 00 L/ < <br /> F <br /> UPON APPROVAL: APPLICANT MUST POST COPY OF <br /> SIGNED PERMIT APPLICATION IN PLAIN SIGHT 0 <br /> -Cr <br /> Transcendent: Page 1 of 4 m <br /> Laserfische: - Burnett County, WI Land Use Application—Rev 12/2020 <br /> m <br /> O <br /> a <br />